ABSTRACT
Objetivos: El tratamiento de las infecciones por Gram positivos supone un reto asistencial, en un contexto en el que están aumentando las resistencias antibióticas. La dalbavancina, gracias a su alta vida media y alta actividad frente a Gram positivos, puede ser una buena opción terapéutica. Nuestros objetivos son conocer los usos, efectividad y eficiencia de la dalbavancina en pacientes del Hospital General Universitario de Valencia. Métodos: Se realiza un estudio descriptivo retrospectivo y un análisis de costes de los pacientes tratados con dalbavancina en el Hospital General Universitario de Valencia. Resultados: 15 pacientes (con 17 episodios de infección) fueron incluidos, con un Charlson medio de 3,7. Se trataron 4 infecciones de piel y partes blandas, 6 infecciones osteoarticulares y 7 infecciones intravasculares, aislándose en el 70,6% de los casos un Gram positivo. La tasa de curación fue del 59%, sin efectos adversos por la dalbavancina ni exitus en relación con la infección. Se evitaron 239 días de hospitalización, lo cual supone un ahorro de 6.556,02 por paciente. Conclusiones: Series clínicas como la actual permiten analizar el papel de la dalbavancina en la práctica médica habitual y demuestran su importante función en el ahorro de recursos económicos. (AU)
Objectives: The treatment of Gram-positive infections its a medical challenge, in a context in which antibiotic resistances are increasing. Dalbavancin, due to its long half-life and high activity against Gram-positive bacteria, could be a good therapeutic option. Our objectives are to know the uses, effectiveness and efficiency of dalbavancin in patients of the General University Hospital of Valencia. Methods: A retrospective descriptive study and a cost analysis of patients treated with dalbavancin are carried out at the General University Hospital of Valencia. Results: 15 patients (with 17 episodes of infection) were included, with a mean Charlson index of 3.7. Were treated 4 skin and soft tissue infections, 6 osteoarticular infections and 7 intravascular infections. A Gram-positive bacteria was isolated in 70.6% of the patients. The cure rate was 59%, with no adverse effects due to dalbavancin or death in relation to infection. 239 days of hospitalization were saved with outpatient treatment, which means a saving of 6,556.02 per patient. Conclusions: Clinical series like ours allow us to analyse the role of dalbavancin in routine medical practice and demonstrate its important function in saving economic resources. (AU)
Subject(s)
Humans , Effectiveness , Efficiency , Infections , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/therapyABSTRACT
BACKGROUND: Antibiotic resistance in Gram-negative bacilli poses a serious problem for public health. In hospitals, in addition to high mortality rates, the emergence and spread of resistance to practically all antibiotics restricts therapeutic options against serious and frequent infections. OBJECTIVE: The aim of this work is to present the views of a group of experts on the following aspects regarding resistance to antimicrobial agents in Gram-negative bacilli: 1) the current epidemiology in Spain, 2) how it is related to local clinical practice and 3) new therapies in this area, based on currently available evidence. METHODS: After reviewing the most noteworthy evidence, the most relevant data on these three aspects were presented at a national meeting to 99 experts in infectious diseases, clinical microbiology, internal medicine, intensive care medicine, anaesthesiology and hospital pharmacy. RESULTS AND CONCLUSIONS: Subsequent local debates among these experts led to conclusions in this matter, including the opinion that the approval of new antibiotics makes it necessary to train the specialists involved in order to optimise how they use them and improve health outcomes; microbiology laboratories in hospitals must be available throughout a continuous timetable; all antibiotics must be available when needed and it is necessary to learn to use them correctly; and the Antimicrobial Stewardship Programs (ASP) play a key role in quickly allocating the new antibiotics within the guidelines and ensure appropriate use of them.
Subject(s)
Anti-Bacterial Agents , Anti-Infective Agents , Humans , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial , Spain/epidemiology , Gram-Negative Bacteria , Anti-Infective Agents/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Coronavirus Infections/drug therapy , Severe acute respiratory syndrome-related coronavirus/pathogenicity , Lopinavir/pharmacokinetics , Ritonavir/pharmacokinetics , Acute Chest Syndrome/drug therapy , Darunavir/pharmacokinetics , Cobicistat/pharmacokinetics , Decision Making , Policy Making , Pandemics/prevention & controlABSTRACT
INTRODUCTION: Incidence of Rhodococcus equi (R. equi) infection is increasing parallel to a greater prevalence of immunosupressed patients. This study aims to describe clinico-epidemiological characteristics of R. equi infections in a single hospital. METHODS: Retrospective, observational study that includes any patient diagnosed of R. equi infection during the 1999-2007 period. Clinical and epidemiological characteristics were recorded. RESULTS: Four patients were diagnosed of R. equi infection, with a mean age of 37.75+/-9.94 years old. All of them were male, infected with human immunodeficiency virus, and showed severe immunosuppression (mean CD4+ lymphocyte count of 83+/-55.2 cells/microl). Respiratory symptoms and cavitary pulmonary lesions were constantly present. R. equi was always cultured in blood and respiratory secretions. CONCLUSIONS: R. equi infection is a rare disease that occurs predominantly in HIV infected patients, severely immunosuppressed patients and almost always causes cavitary pneumonia.
Subject(s)
Actinomycetales Infections/etiology , HIV Infections/complications , Rhodococcus equi , Adult , Humans , Male , Retrospective StudiesABSTRACT
IntroducciónLa incidencia de la infección por Rhodococcus equi está incrementándose en paralelo con la mayor prevalencia de pacientes inmunodeprimidos. Este estudio se propone conocer las características clínico-epidemiológicas de las infecciones por R. equi en un único centro.MétodosEstudio retrospectivo, de observación, que incluye a todos los pacientes diagnosticados de infección por R. equi en el período 19992007. Se registraron características clínicas y epidemiológicas generales.ResultadosSe diagnosticó a cuatro pacientes de infección por R. equi, de 37,75±9,94 años de edad, todos ellos varones infectados por el virus de la inmunodeficiencia humana (VIH), con inmunosupresión importante (contaje medio de linfocitos CD4+: 83±55,2 células/μl). Todos los pacientes tenían sintomatología respiratoria y mostraban lesiones pulmonares radiológicas cavitadas. Se aisló R. equi tanto en sangre como en muestras respiratorias.ConclusionesLa infección por R. equi es poco frecuente, incide sobre todo en pacientes con infección por VIH muy inmunodeprimidos y cursa casi siempre como neumonía cavitada(AU)
IntroductionIncidence of Rhodococcus equi (R. equi) infection is increasing parallel to a greater prevalence of immunosupressed patients. This study aims to describe clinico-epidemiological characteristics of R. equi infections in a single hospital.MethodsRetrospective, observational study that includes any patient diagnosed of R. equi infection during the 19992007 period. Clinical and epidemiological characteristics were recorded.ResultsFour patients were diagnosed of R. equi infection, with a mean age of 37,75±9,94 years old. All of them were male, infected with human immunodeficiency virus, and showed severe immunosuppression (mean CD4+ lymphocyte count of 83±55,2 cells/μl). Respiratory symptoms and cavitary pulmonary lesions were constantly present. R. equi was always cultured in blood and respiratory secretions.ConclusionsR. equi infection is a rare disease that occurs predominantly in HIV infected patients, severely immunosuppressed patients and almost always causes cavitary pneumonia(AU)
Subject(s)
Humans , Male , Adult , Middle Aged , Rhodococcus equi/isolation & purification , Rhodococcus equi/pathogenicity , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/diagnosis , Pneumonia/complications , Pneumonia/diagnosis , Macrolides/therapeutic use , Quinolones/therapeutic use , Retrospective Studies , Signs and Symptoms , Liver Diseases/complications , Radiography, Thoracic , Anti-Retroviral Agents/therapeutic useSubject(s)
Anus Diseases/diagnosis , Tuberculosis, Gastrointestinal/diagnosis , Humans , Male , Middle Aged , Time FactorsABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Perianal Glands/injuries , Perianal Glands , Fistula/diagnosis , Biopsy/methods , Fibrosis/complications , Tomography, Emission-Computed/methods , Mycobacterium tuberculosis/isolation & purification , Isoniazid/therapeutic use , Rifampin/therapeutic useSubject(s)
Ascites/etiology , Corynebacterium Infections , Corynebacterium/isolation & purification , Anti-Bacterial Agents/therapeutic use , Ascitic Fluid/microbiology , Corynebacterium Infections/drug therapy , Corynebacterium Infections/microbiology , Humans , Neutrophils , Peritonitis/etiology , Peritonitis/microbiologySubject(s)
Tularemia/epidemiology , Adult , Disease Outbreaks , Humans , Male , Spain/epidemiology , Tularemia/diagnosisABSTRACT
Pancreatic involvement has been studied in 70 HIV infected patients, in diverse stages, that were treated with didanosine (ddI), both as monotherapy or associated to zidovudine; 38% of patients presented adverse reaction that obliged to withdraw the medication: pancreatitis (4%), hyperamylasemia (21%) and abdominal pain and/or diarrhea (12%). The possible causes in presentation of adverse effects were evaluated: route of infection, stage of HIV infection, use of pentamidine or trimethoprim-sulfamethoxazole for preventing Pneumocystis carinii pneumonia, administration of ddI in monotherapy or in combined form with zidovudine, time of treatment and level of CD4 lymphocytes. The outcome of adverse effects is related significantly only with the most advanced stage of HIV infection.
Subject(s)
Antiviral Agents/adverse effects , Didanosine/adverse effects , HIV Infections/drug therapy , Pancreatic Diseases/chemically induced , Acute Disease , Antiviral Agents/administration & dosage , CD4 Lymphocyte Count , Didanosine/administration & dosage , Drug Therapy, Combination , Female , HIV Infections/immunology , Humans , Male , Pancreatitis/chemically induced , Zidovudine/administration & dosageABSTRACT
Rickettsia spp. infections produce hepatic damage with transaminases elevation and biological signs of cholostasis. Classical biochemical tests of hepatic function were analyzed and compared in 8 patients with Q Fever (QF) and 7 with Boutonneuse Mediterranean Fever (BMF). Liver enlargement was detected in 75% of the QF group of patients as compared with the 57% of the BMF group. Transaminases were raised in 75% of the patients of the QF group and in 85, 7% of the BMF patients. Only one patient in the QF group showed manifest clinical jaundice. Statistically significant differences were found between the values of AST, ALT, alkaline phosphatase and GGT, which were higher in the QF group. Liver involvement is more important in patients with QF than in FBM. There is a large percentage of clinically silent involvement in both diseases. Liver function tests should be carried out in infections by Rickettsia spp.
